1. To find documents related to your coverage, start by selecting
your state and your Medicare plan.
2. Select the state you reside in.
5. Download Plan Documents
General Documents
- CSNP Enrollment Form
- CSNP Enrollment Application
- 2025 MAPD Attestation & Enrollment Form
- 2026 MAPD Attestation
- 2026 Provider Attestation for SSBCI Benefits
- MAPD Enrollment Application
- MAPD Scope of Appointment
- 2025 MAPD Enrollment Form
- 2026 MAPD Enrollment Form
- Over-the-Counter (OTC) Product Catalog
- Admissions Form
- Appeal Form
- Appointment of Representative Form
- BAE Policy
- Coverage Determination Request Form
- Disenrollment Form
- Grievance Form
- Mail Order Drug Form
- Medical Reimbursement Claim Form
- Medication Therapy Management (MTM) Overview
- Medication Therapy Management (MTM) - Personal Rx List
- Prescription Drug Claim Form
- Privacy (HIPAA) Authorization Form
- Prior Authorization - Medical Services List